title: [Incidence of unplanned extubations in a neonatal intensive care unit. A before and after study].
abstract: BACKGROUND
  Unplanned extubations (UE) of mechanically ventilated newborns involves an undesirable increase in morbidity and mortality.
  
  
  OBJECTIVE
  A 2-stage study compared the frequency of UE in a Neonatal Intensive Care Unit before and after the implementation of a program of preventive measures to decrease UE.
  
  
  METHODS
  A before and after prospective study included all mechanically ventilated newborns participating in the 2 stage study from May-December 2011 and June-December 2012. In stage 1, the rate of UE per 100 intubated patient days was calculated and the characteristics of unplanned extubated newborns, circumstances of UE occurrence and need for re-intubation were studied. Consequently, a program of preventive measures for UE was designed and implemented, with the same variables being analysed in stage 2.
  
  
  RESULTS
  No differences were found in patient characteristics during the two stages. Stage 1, incidence of UE was 5/100 intubated patient days; Stage 2, 4.5 UE/100 intubated patient days (P=.657). In both stages, most UE occurred during patient handling with re-intubation incidence at 77.4% and 67.7%, respectively. The combined rate of both stages during summer months of July, August and September was 6.2 UE/100 intubation days, in contrast with the remaining months of both stages: UE incidence rate, 3.4 UE/100 intubation days (p=.043).
  
  
  CONCLUSIONS
  The implementation of a preventive measures program did not significantly reduce the incidence of UE. The summer period showed the highest incidence of UE.
authors.affiliation: Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: isabelutrera@hotmail.com.
authors.forename: M I
authors.initials: MI
authors.lastname: Utrera Torres
authors.affiliation: Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: M T
authors.initials: MT
authors.lastname: Moral Pumarega
authors.affiliation: Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: N R
authors.initials: NR
authors.lastname: García Lara
authors.affiliation: Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Melgar Bonís
authors.affiliation: Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: M E
authors.initials: ME
authors.lastname: Frías García
authors.affiliation: Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: C R
authors.initials: CR
authors.lastname: Pallás Alonso
mesh_terms: D060666:Airway Extubation / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D011446:Prospective Studies; D058996:Quality Improvement
keywords: Accidental extubation; Autoextubación; Endotracheal intubation; Extubación accidental; Extubación no programada; Intubación endotraqueal; Neonatal intensive care unit; Self-extubation; Unidad de cuidados intensivos neonatales; Unplanned extubation